Infection prevention and control of highly infectious pathogens in resource-limited countries: an experience from Marburg viral disease outbreak in Kagera Region - Tanzania.

Marburg viral disease (MVD) is a highly infectious disease with a case fatality rate of up to 90%, particularly impacting resource-limited countries where implementing Infection Prevention and Control (IPC) measures is challenging. This paper shares the experience of how Tanzania has improved its capacity to prevent and control highly infectious diseases, and how this capacity was utilized during the outbreak of the MVD disease that occurred for the first time in the country in 2023.In 2016 and the subsequent years, Tanzania conducted self and external assessments that revealed limited IPC capacity in responding to highly infectious diseases. To address these gaps, initiatives were undertaken, including the enhancement of IPC readiness through the development and dissemination of guidelines, assessments of healthcare facilities, supportive supervision and mentorship, procurement of supplies, and the renovation or construction of environments to bolster IPC implementation.The official confirmation and declaration of MVD on March 21, 2023, came after five patients had already died of the disease. MVD primarily spreads through contact and presents with severe symptoms, which make patient care and prevention challenging, especially in resource-limited settings. However, with the use of a trained workforce; IPC rapid needs assessment was conducted, identifying specific gaps. Based on the results; mentorship programs were carried out, specific policies and guidelines were developed, security measures were enhanced, all burial activities in the area were supervised, and both patients and staff were monitored across all facilities. By the end of the outbreak response on June 1, 2023, a total of 212 contacts had been identified, with the addition of only three deaths. Invasive procedures like dialysis and Manual Vacuum Aspiration prevented some deaths in infected patients, procedures previously discouraged.In summary, this experience underscores the critical importance of strict adherence to IPC practices in controlling highly infectious diseases. Recommendations for low-income countries include motivating healthcare providers and improving working conditions to enhance commitment in challenging environments. This report offers valuable insights and practical interventions for preparing for and addressing highly infectious disease outbreaks through implementation of IPC measures.

Burden of leprosy and associated risk factors for disabilities in Tanzania from 2017 to 2020.

BACKGROUND: Leprosy is caused by Mycobacterium leprae which affects skin, nerves, eyes, and nasal mucosa. Despite global elimination efforts, Tanzania remains among 13 countries reporting more than 1000 leprosy cases annually. In 2021, Tanzania identified 1,511 new cases, with 10% having grade II disability. Moreover, 14 councils recorded leprosy rates exceeding 10 cases per 100,000 population. This study aimed to assess the burden of leprosy and associated risk factors for disabilities in Tanzania from 2017 to 2020. METHODOLOGY: A retrospective cross-sectional study was conducted to investigate all registered treated leprosy patients from January 2017 to December 2020. The Leprosy Burden Score (LBS) was used to assess the disease burden, while binary logistic regression was employed to evaluate the risk factors for disability. RESULT: A total of 6,963 leprosy cases were identified from 2017 to 2020. During this period, the point prevalence of leprosy declined from 0.32 to 0.25 per 10,000 people, and the new case detection rate decreased from 3.1 to 2.4 per 100,000 people; however, these changes were not statistically significant (p > 0.05). Independent risk factors for leprosy-related disabilities included male sex (Adjusted Odds Ratio (AOR) = 1.38, 95% Confidence Interval (CI) 1.22-1.57), age 15 years and above (AOR = 2.42, 95% CI 1.60-3.67), previous treatment history (AOR = 2.18, 95% CI 1.69-2.82), and positive Human Immunodeficiency Virus (HIV) status (AOR = 1.60, 95% CI 1.11-2.30). CONCLUSION: This study identified male sex, older age, positive HIV status, and prior treatment history as independent risk factors for leprosy-related disabilities. Additionally, despite the observed decline in point prevalence and new case detection rates, these changes were not statistically significant. To address leprosy-related disabilities, it is crucial to implement specific prevention strategies that focus on high-risk groups. This can be accomplished by enhancing screening and contact tracing efforts for early patient identification to prevent delays in intervention. Further research is warranted to analyze the burden of leprosy over a more extended period and to explore additional risk factors not covered in this study.

Epidemiological description of Marburg virus disease outbreak in Kagera region, Northwestern Tanzania.

INTRODUCTION: In March 2023, a Marburg Virus Disease (MVD) outbreak was declared in Kagera region, Northwestern Tanzania. This was the first MVD outbreak in the country. We describe the epidemiological characteristics of MVD cases and contacts. METHODS: The Ministry of Health activated an outbreak response team. Outbreak investigation methods were applied to cases identified through MVD standard case definitions and confirmed through reverse-transcriptase polymerase chain reaction (RT PCR). All identified case contacts were added into the contact listing form and followed up in-person daily for any signs or symptoms for 21 days. Data collected from various forms was managed and analyzed using Excel and QGIS software for mapping. RESULTS: A total of nine MVD cases were reported with eight laboratory-confirmed and one probable. Two of the reported cases were frontline healthcare workers and seven were family related members. Cases were children and adults between 1-59 years of age with a median age of 34 years. Six were males. Six cases died equivalent to a case fatality rate (CFR) of 66.7%. A total of 212 individuals were identified as contacts and two (2) became cases. The outbreak was localized in two geo-administrative wards (Maruku and Kanyangereko) of Bukoba District Council. CONCLUSION: Transmission during this outbreak occurred among family members and healthcare workers who provided care to the cases. The delay in detection aggravated the spread and possibly the consequent fatality but once confirmed the swift response stemmed further transmission containing the disease at the epicenter wards. The outbreak lasted for 72 days but as the origin is still unknown, further research is required to explore the source of this outbreak.